Provider Demographics
NPI:1730350489
Name:GREGORY L & MARIA E. THOMAS DBA A-1 HEALTHCARE CENTER
Entity type:Organization
Organization Name:GREGORY L & MARIA E. THOMAS DBA A-1 HEALTHCARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-518-5431
Mailing Address - Street 1:1205 N MELROSE DR
Mailing Address - Street 2:STE #N
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-3473
Mailing Address - Country:US
Mailing Address - Phone:760-945-4700
Mailing Address - Fax:760-945-0382
Practice Address - Street 1:1205 N MELROSE DR
Practice Address - Street 2:STE #N
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-3473
Practice Address - Country:US
Practice Address - Phone:760-945-4700
Practice Address - Fax:760-945-0382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43100332B00000X
CA72304332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME02323FMedicaid
CADME02323FMedicaid
CA=========OtherEIN